Memo

TITLE OF BILL: An act to amend the insurance law, in relation to the purchase of prescription drugs

PURPOSE OR GENERAL IDEA OF BILL: The purpose of this bill is to ensure that fertility drugs may be purchased locally without additional financial burden to the insured person.

SUMMARY OF SPECIFIC PROVISIONS: This bill would amend the insurance law with respect to HMOs, and individual, group and not-for-profit insurance policies by requiring all policies that provide coverage for fertility drugs and require or permit a mail order pharmacy benefit to cover prescription fertility drugs purchased at a non-mail order pharmacy without any additional cost sharing to the covered individual.

JUSTIFICATION: In an effort to streamline the delivery of prescription drugs while maintaining the affordability of coverage, many health insurance policies require or incentivize the use of a mail order pharmacy. Nevertheless, the effectiveness of many fertility drugs relies on a strict treatment regimen that is often difficult or impossible to maintain when using a mail order pharmacy. Shipping and processing delays may impair these drugs' ability to produce the desired effect at a cost to both insureds and insurance companies themselves. This bill would ensure that individuals with prescription drug coverage have an equal opportunity to purchase fertility drugs from either a mail order or non-mail order pharmacy.

PRIOR LEGISLATIVE HISTORY: New Bill.

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS: None.

EFFECTIVE DATE: Thirty days following enactment and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such effective date.

Text

STATE OF NEW YORK
________________________________________________________________________
5799
2011-2012 Regular Sessions
IN SENATE
June 16, 2011
___________

Introduced by Sen. SKELOS -- read twice and ordered printed, and when
printed to be committed to the Committee on Rules
AN ACT to amend the insurance law, in relation to the purchase of
prescription drugs
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subsection (i) of section 3216 of the insurance law is
amended by adding a new paragraph 13-a to read as follows:
(13-A) EVERY POLICY THAT PROVIDES COVERAGE FOR PRESCRIPTION FERTILITY
DRUGS AND REQUIRES OR PERMITS PRESCRIPTION DRUGS TO BE PURCHASED THROUGH
A MAIL ORDER PHARMACY SHALL PROVIDE THE SAME COVERAGE FOR PRESCRIPTION
FERTILITY DRUGS WHEN SUCH DRUGS ARE PURCHASED FROM A PHARMACY THAT IS
NOT A MAIL ORDER PHARMACY. SUCH POLICY SHALL NOT IMPOSE ANY ADDITIONAL
FEE, CO-PAYMENT, CO-INSURANCE, DEDUCTIBLE OR OTHER CONDITION ON ANY
INSURED WHO DOES NOT ELECT TO PURCHASE PRESCRIPTION FERTILITY DRUGS
THROUGH A MAIL ORDER PHARMACY.
S 2. Paragraph 6 of subsection (k) of section 3221 of the insurance
law is amended by adding a new subparagraph (D) to read as follows:
(D) EVERY POLICY THAT PROVIDES COVERAGE FOR PRESCRIPTION FERTILITY
DRUGS AND REQUIRES OR PERMITS PRESCRIPTION DRUGS TO BE PURCHASED THROUGH
A MAIL ORDER PHARMACY SHALL PROVIDE THE SAME COVERAGE FOR PRESCRIPTION
FERTILITY DRUGS WHEN SUCH DRUGS ARE PURCHASED FROM A PHARMACY THAT IS
NOT A MAIL ORDER PHARMACY. SUCH POLICY SHALL NOT IMPOSE ANY ADDITIONAL
FEE, CO-PAYMENT, CO-INSURANCE, DEDUCTIBLE OR OTHER CONDITION ON ANY
COVERED PERSON WHO DOES NOT ELECT TO PURCHASE PRESCRIPTION FERTILITY
DRUGS THROUGH A MAIL ORDER PHARMACY.
S 3. Subsection (s) of section 4303 of the insurance law, as amended
by section 2 of part K of chapter 82 of the laws of 2002, is amended by
adding a new paragraph 4 to read as follows:
(4) EVERY POLICY ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION, A
HOSPITAL SERVICE CORPORATION OR A HEALTH SERVICES CORPORATION THAT

EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10740-02-1

S. 5799 2

PROVIDES COVERAGE FOR PRESCRIPTION FERTILITY DRUGS AND REQUIRES OR
PERMITS PRESCRIPTION DRUGS TO BE PURCHASED THROUGH A MAIL ORDER PHARMACY
SHALL PROVIDE THE SAME COVERAGE FOR PRESCRIPTION FERTILITY DRUGS WHEN
SUCH DRUGS ARE PURCHASED FROM A PHARMACY THAT IS NOT A MAIL ORDER PHAR-
MACY. SUCH POLICY SHALL NOT IMPOSE ANY ADDITIONAL FEE, CO-PAYMENT,
CO-INSURANCE, DEDUCTIBLE OR OTHER CONDITION ON ANY COVERED PERSON WHO
DOES NOT ELECT TO PURCHASE PRESCRIPTION FERTILITY DRUGS THROUGH A MAIL
ORDER PHARMACY.
S 4. If any clause, subparagraph, subsection, section or other part
of this act, or the application thereof be held to be invalid, such
holding shall not affect, impair or invalidate the remainder of this
act, or the application of such section or part of a section held inval-
id.
S 5. This act shall take effect on the thirtieth day after it shall
have become a law and shall apply to all policies and contracts issued,
renewed, modified, altered or amended on or after such effective date.

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